Dr. Ashraf M. Elsayegh program at the idg meeting

During the IDG General Meeting on March 20, 2025, Dr. Ashraf M. Elsayegh, Director of the Providence Saint John’s Health Center’s Disaster Relief Pulmonary Clinic, delivered an informative presentation on the mission and work of the Clinic, with a focus on its response to the Palisades Fire and the impact on respiratory health in the local community.

PROGRAM PRESENTATION:
Programs Co-Chair Panthea Shafipour introduced our esteemed speaker for today’s meeting, Dr. Ashraf M. Elsayegh, Director of the Providence Saint John’s Health Center’s Disaster Relief Pulmonary Clinic. Dr. Elsayegh is a leading pulmonologist in Los Angeles. He has held leadership roles at Cedars Sinai and UCLA’s David Geffen School of Medicine, as well as his current role in the development of a comprehensive pulmonary program at Saint John’s and the new Disaster Relief Pulmonary Clinic located on the first floor of the hospital. He is a resident of the Palisades community and he lost his home in the fires. So he has very personal experience with the disaster we all have witnessed. He is here today to share critical information regarding the aftermath of the recent fires in our community, and to explain how the pulmonary clinic works and what it can offer to victims.
The clinic was conceived as a place which could serve the people who 1) live in the fire areas, who 2) work in the fire areas, as well as 3) the first responders.

Dr. Elsayegh said that the clinic opened very quickly after the fires occurred and has been open now for a little over two months. He was gratified to learn that not only did it begin right away serving Palisades fire victims, but just as great a number of people are coming to visit the clinic from the Eaton fire area.
The biggest thing to understand about these fires is that they are unprecedented. We have never had modern-day fire so huge, in terms of size and in the amount of destruction. It was a forest fire along with an urban fire. We have nothing to compare it to. For example, the Word Trade Center bombing had terrible loss of life, yet the actual amount of ground and buildings that it covered was small in comparison to ours. We have two main problems – the air quality is the first. The AQI, which was constantly measured and reported on during and after the fire, measures the quality in terms of the amount smoke but it does not actually measure the toxins in the air. To measure the toxins, the equipment needed is huge, cumbersome and not readily available. The toxins he talked about are called Volatile Organic Compounds (VOC). He listed some of the toxins, which include silica, lead, asbestos, benzene and lithium. Immediate, short-term problems which arise from ingestion of VOCs are asthma exacerbations. We continue to learn about longer-term effects as time goes on. When a house burns down, there are so many different elements released into the air and the ground – from furniture, fabrics, batteries from cars, cleaning products, pool maintenance products, etc. If you read the fine print on most of these products, it will say that the contents could be carcinogenic. On a small, isolated scale, this is not considered a huge problem. But when thousands of homes in the same area burn down, the toxins become a much, much larger problem. Ironically, even the fire retardants that are used in fighting the fire actually have a lot of metals in them and can create toxins as well. And of course, as well as affecting the air quality the toxins will affect water quality. The Palisades water was finally announced to be safe to use just last week.
We have all heard of specific long-term respiratory problems caused by silica or asbestos as time passes, but we have not had a lot of experience in the toxins which may cause cancers later. Most VOCs are carcinogenic, some can cause lung damage, others can cause birth defects. And, as with all risks, they are more intense for elderly people, children, and pregnant women.
Another important problem which Dr. Elsayegh always like to stress is the risk to mental health – stress, depression and PTSD. The fire affected not only thousands of adults, but also thousands of children and teenagers, and their mental health needs to be addressed as well as their physical health.
First responders, the firemen who work the fires, show signs of breathing distress and lowered pulmonary function immediately after the fire. We do not really know how long this condition persists, and there will be individual variations, so follow-ups will be important for them. One thing that we did learn from the World Trade Center disaster was that workers were sent in to clean up too soon, exposing them to more of the toxins. There was more of a time lapse in our response for cleanup teams here in Los Angeles, in an effort to avoid some of the problems which occurred with those Trade Center workers.

Dr. Elsayegh’s breakdown of post-fire pulmonary phases:
1. Immediate – First- and second-month workers. Typically, asthma-related problems and allergic reactions
2. “The Disaster after the Disaster” – After the fires have been extinguished, there are many respiratory complications during the CLEANUP PHASE. Ash can retain toxins for up to two years. Los Angeles has only recently begun sending in the cleanup teams to the fire areas. Cleanup should take place after the ash has been wetted down to keep it from spreading in the air, and that is what they are doing. Anyone who privately hires cleanup workers for their property should be sure they are doing the wetting down as well. Fortunately, the rain has helped reduce the spread of air toxins. Also, workers (and homeowners who choose to partake in doing any of the cleanup) need to wear N95 masks, goggles, disposable hazmat suits (painter suits are okay) which can be thrown away after use, gloves, sturdy thick soled footwear/boots. Workers should make sure they are up to date with their tetanus shots. And everyone should clean their shoes, clothes and any pets with baby wipes afterward. ASH SHOULD NOT BE SWEPT UP. It should be vacuumed, with special approved Ash Hepa Vacuums. Any air purifiers used in the home should be rated with MERV of 13 or higher. There should be an air purifier for every 200-250 sq ft.) Other sources of problems are pools and jacuzzies. Water will accumulate there and become a source for mosquito breeding and all the problems mosquitoes can bring. The city and county cleaning crews will not be cleaning and emptying pools. Homeowners need to be aware.
3. Long-term respiratory problems. These can occur/develop 2-5 years (or even longer) post exposure. Most often this will be related to LAFD, LAPD, DWP or cleanup crews.

Dr. Elsayegh ended his presentation by summarizing what we are doing at Saint John’s:

• Started a Disaster Relief Clinic, for anyone exposed including firefighters, LAPD, LADWP. Dr. Elsayegh believes that the clinic will need to remain open for 4, 5 or 6 years, although hopefully the number of affected patients will be reduced over time.
• Community outreach programs, including direct education, and an evaluation of pulmonary health
• Videos and Webinars, using experts to speak and educate the public

There were many questions asked and addressed during Dr. Elsayegh’s talk, but he was kind enough to stay and answer a few more afterwards. One question was in regard to using public parks with pets in the Highlands or in the Brentwood or Westwood areas. He told us that the good thing about the Highlands was that about 40% of the homes there were lost, compared to close to 90% up close to the Village. So, there will be less toxins, and a greater opportunity for the fresh coastal air to carry off the dust in the air. He said he would recommend still wearing an N95 mask in the Palisades when outside DURING THE CLEANUP PHASE.

For kids activities:
Question about summer camp on the beach next summer. Safe? Probably. IF the CLEANUP IS COMPLETE, beach should be okay. Try to make the decision in another couple of months.
Sports for kids at playgrounds and parks in Brentwood, Westwood or other nearby areas, e.g. soccer. Sports are so good for kids; we want to get them out if possible. Probably okay, unless you can smell ash in the air. Use your car as a judge. Ash will accumulate if it is there.
Another question was about the safety of sending students back to Palisades High in the Fall when they open for in-person instruction. He says to play it by ear. IF ALL OF THE CLEANUP IS FINISHED, and there is construction only going on, that should be safe. The construction is not a problem. The cleanup in the Palisades is progressing at a fast pace. There are reportedly about 58 crews working at present, with plans of increasing that number to 100 crews as soon as possible.
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Anyone interested in making an appointment or getting other information for the Disaster Relief Pulmonary Clinic may telephone 310-829-8704.